Active NPI
Roxanne Kay Cornelius, PA-C
- Medical Physician Assistant
- Grand Rapids, MI
National Provider Identifier
1467798231
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 5601003078
- Practice address
- 555 Midtowne St NE
Suite 110
Grand Rapids, MI 49503-5729 - Phone
- (616) 588-8880
- NPI assigned
- Dec 21, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 5601003078 | MI | Primary |
Addresses
Primary practice location
555 Midtowne St NE
Suite 110
Grand Rapids, MI 49503-5729
Mailing address
8849 Tamarisk Circle
Richland, MI 49083
Phone (269) 501-3143
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601003078 | MI | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bradley Bengtson, M.D. PC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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- Grand Rapids, MI
- NPI 1013234707
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1356048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1356048000000",
"number": "1467798231",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8849 TAMARISK CIRCLE",
"city": "RICHLAND",
"state": "MI",
"postal_code": "49083",
"telephone_number": "269-501-3143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "555 MIDTOWNE ST NE",
"address_2": "SUITE 110",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495035729",
"telephone_number": "616-588-8880"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORNELIUS",
"first_name": "ROXANNE",
"middle_name": "KAY",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-12-21",
"last_updated": "2012-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "MI",
"license": "5601003078",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.